Salt, sex and exercise at ECTRIMS – Day 2
This week, Copenhagen is hosting the 29th meeting of ECTRIMS (European Committee for Treatment and Research in MS), the largest annual gathering of physicians and researchers specialized in MS.
Sex hormones influence MS
It’s well known that estrogens can influence MS, as seen by the decline in relapses during pregnancy and a return of relapses after the baby is born. A new study has investigated how declining hormone levels affect MS by looking at how women fare during menopause (Bove and colleagues. ECTRIMS 2013; abstract 113). About 282 postmenopausal women were surveyed about their MS symptoms. Menopause occurred earlier (on average at age 37). In most cases, menopause was because of medical procedures (e.g. hysterectomy) or treatments (e.g. Novantrone) rather than aging. About 45% were taking hormone replacement therapy.
Most women found that the onset of menopause wasn’t associated with more relapses or worsening disability, however, one-third said they were worse off. About one-half reported problems with MS symptoms. The most common were sexual function, bladder symptoms, fatigue, difficulties with memory or concentration, and depression. Another problem was that menopausal hot flashes triggered a worsening of relapse symptoms. It wasn’t established if hormone replacement therapy eases any of these MS symptoms.
Changes in hormone levels can also affect men. An analysis of men treated at an MS centre in Boston found that men with lower testosterone levels had more disability and poorer mental function (Bove and colleagues. ECTRIMS 2013; abstract P318). A pilot study also found that a year of testosterone treatment appeared to slow neurodegeneration in men with MS (Kurth and colleagues. ECTRIMS 2013; abstract P568). Several years ago, a pilot study found that testosterone gel improved mental functioning in men with relapsing-remitting MS (Sicotte and colleagues. Arch Neurol 2007;64:683-688), but larger studies are needed.
Low salt diet may benefit relapses
Following a laboratory study that suggested that dietary salt made immune cells more aggressive, researchers in Argentina and the U.S. have investigated whether a low-salt diet affects MS (Farez and colleagues. ECTRIMS 2013; abstract 119).
Compared to people with a low-salt diet, those with medium salt consumption had close to a 3-fold higher risk of relapses. People with a high-salt diet had a 4-fold increased relapse risk. Higher salt intake was also correlated with greater inflammatory activity on MRI.
While these are very preliminary results, they do reinforce the benefits (for MS and other medical conditions such as heart disease) of restricting salt intake.
Benefits of exercise
Regular exercise can provide important benefits to people with MS, helping to improve posture and gait, strengthen and stabilize muscles and give a boost to well-being. Regular activity rather than the type of exercise appears to the most important factor. But several new studies have looked at specific types of exercise and what can be gained.
A study in the U.K. found that Pilates, which helps to strengthen the body core, helped to improve mobility and walking speed (Fox and colleagues. ECTRIMS 2013; abstract 130). For a previous story, see Pilates can help mobility and balance, MSology, June 27, 2013.
Also helpful is Tai Chi. A pilot study in India found that 20 sessions (40 or 60 minutes per session) of Tai Chi improved walking ability, balance and stability (Kaur and colleagues. ECTRIMS 2013; abstract P707).
For the more adventurous, rock climbing has been shown to improve muscle performance and balance (Jolk and colleagues. ECTRIMS 2013; abstract P713). All participants were novice climbers with some mild disability at the start. Improvements were seen after as few as five two-hour sessions. A separate study by the same researchers found that resistance training (such as with weight machines) was effective for strengthening and stabilizing the muscles (Bernhardt and colleagues. ECTRIMS 2013; abstract P1179). Participants saw a benefit when they exercised as little as 60 minutes per week.
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